The Current State of Home Health Care in Puerto Rico

Assess home health care (HHC) agency coverage in Puerto Rico (PR), a U.S. territory, and compare PR agencies with those in the U.S. (excluding PR) and in a subset of counties outside of PR with high Puerto Rican populations (CHPRPs).

PR HHC coverage was mapped using data from 2020 U.S. Census ZIP Code Tabulation Area (ZCTA) and publicly available Centers for Medicare and Medicaid Services (CMS) files. Descriptive statistics on HHC agencies, patients and Medicare beneficiaries were calculated from publicly available CMS data. Pearson's χ2, Fisher's exact, or t tests were used to compare PR agencies with U.S. (excluding PR) and CHPRP agencies.

Nearly all PR ZCTAs were served by ≥7 HHC agencies. Compared with U.S. and CHPRP agencies, those in PR have higher nonprofit ownership, higher Medicare Advantage (MA) enrollment, and better fall prevention and quality of patient care, but lower performance in timely HHC initiation, patient influenza vaccination, and patient experience.

PR HHC agencies excel in patient improvement metrics, with opportunities to strengthen patient experience and preventive care. Future research should examine factors underlying observed differences, and MA enrollee access to and use of HHC.